12/9/2015 1 Breastfeeding: Good for Babies and their Gut Bacteria! Meghan Azad, PhD & Lorena Vehling, BSc Children’s Hospital Research Institute of Manitoba Department of Pediatrics & Child Health, University of Manitoba Canadian Healthy Infant Longitudinal Development (CHILD) Study [email protected]@MeghanAzad Breastfeeding Rounds – December 9, 2015 Sponsored by the Manitoba Baby Friendly Committee Objectives 1. Understand how the microbiome develops during infancy 2. Identify factors in early life that influence microbiome development 3. Describe how breastfeeding impacts microbiome development and infant health 4. List key bioactive components of human milk 5. Understand that promoting exclusive breastfeeding during the perinatal period can positively influence long term breastfeeding duration Outline The CHILD Study Gut Microbiome Breast Milk: Nature’s First Functional Food Newborn feeding CHILD Study Video AllerGen Whiteboard 3:39 The Canadian Healthy Infant Longitudinal Development (CHILD) Study How do genes and the environment influence child health and development? • North America’s largest general population pregnancy cohort 3600 children born in 2010 – 2012, four sites in Canada including 1000 in Manitoba • Genetic & environmental exposure assessments Pregnancy, nutrition, infant feeding, psychosocial, home environment, activities… • Biological samples Blood, urine, stool, breast milk • Follow-up to age 5 years (+) Allergies, asthma, obesity… The Canadian Healthy Infant Longitudinal Development (CHILD) Study How do genes and the environment influence child health and development?
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12/9/2015
1
Breastfeeding: Good for Babies and their Gut Bacteria!
Meghan Azad, PhD & Lorena Vehling, BScChildren’s Hospital Research Institute of Manitoba
Department of Pediatrics & Child Health, University of Manitoba
Canadian Healthy Infant Longitudinal Development (CHILD) Study
� World Health Organization recommends:Exclusive breastfeeding up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to 2 years of age or beyond.
� USA: most infants initiate breastfeeding, BUT � Within 1 week, more than half are receiving formula
� By 6 months, less than half are breastfed at all
� Canada: most infants (89%) initiate breastfeeding, BUT � Only 26% are exclusively breastfed to 6 months
� Other studies find lower rates…
Sources:World Health Organization Global strategy on infant and young child feeding 2002. CDC National Immunization Survey 2008. Canadian Community Health Survey 2010-11.
� Antibiotics used to disrupt microbiota in newborn mice
� Microbiota recovered after antibiotic exposure, but immune function and adiposity were permanentlyaltered
The Hygiene Microbiome Hypothesis
Summary (What we know…)
Gut Microbiota
Immunity & Metabolism
Lifelong Health & DiseaseBreastfeeding+ Other Early Exposures
Future Directions (What we don’t know…)
� What does a ‘healthy microbiome’ look like?
� What are the long-term health effects of microbiota dysbiosis resulting from c-section, antibiotics, formula feeding…?
� HOW do microbiota influence disease risk?
� How can we prevent gut microbiota dysbiosis? � Vaginal delivery, breastfeed, avoid unnecessary antibiotics…
� How can we repair gut microbiota dysbiosis? � Vaginal swabs after CS? Breastfeed? Pre/probiotics?
Fecal Transplants?
Probiotics: Live beneficial
bacteria
Prebiotics: Non-digestible
carbohydrates that select for beneficial
bacteria
Slide used with permission from Sonia Semenic
12/9/2015
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http://www.northernstarmilkbank.ca/
Early intensity predicts long-term duration
Lorena Vehling, BSc (Hons)
University of Manitoba
Children’s Hospital Research Institute of Manitoba
Breastfeeding in the CHILD Study
Background
Many mother-infant dyads do not reach the recommended guidelines of exclusive breastfeeding for 6 months
One Canadian study reports only 5% of infants were still exclusively breastfeeding at 6 months1
Factors associated with breastfeeding duration include:
• Maternal education• Method of delivery
• Maternal Ethnicity• Parity
• Breastfeeding self-efficacy
• Prenatal class attendance
• Maternal health status• Maternal Intention
• Paternal infant feeding beliefs
• Perceived infant satisfaction
• Postpartum support• Skin-to-skin care
• In-hospital
supplementation
1. Semenic, S. et al.. "Predictors of the duration of exclusive breastfeeding among first‐time mothers." Research in nursing & health 31.5 (2008): 428-441
OBJECTIVETo describe and explore associations between
breastfeeding initiation, early intensity and duration in a national cohort of
Canadian children.
Methods
Fig. 1 CHILD study
Cohort of 3141 mother-infant dyads from
the CHILD study
Newborn feeding data to determine
breastfeeding status since birth
- Exclusive (only human breast milk)- Partial (supplemented with infant
formula, other fluids or solid food
at any time since birth)- None
Rate ratios were calculated and associations determined using
a Poisson model
Maternal Characteristics in the CHILD Study
%
Maternal Education:
Postsecondary Degree
Yes 76.4
No 23.6
Maternal BMI
Normal 62.4
Overweight 37.6
Parity
Multiparity 53.5
Primiparity 46.5
%
Method of Birth
Vaginal 74.8
Cesarean 25.2
Maternal Ethnicity
Caucasian 72.8
Asian 15.8
First Nations 4.4
Other 7.0
N=2913 children with complete breastfeeding data in the first year, maternal characteristics and were